Would like a rundown on prices so we can compare and make a decision of where to go... Thank you

Cash discount is listed on the home page of this web site and includes all exams, medications and tests done in the clinic including xrays, CBC, UA, chemistries, rapid strep, pregnancy test, RSV, Mono, Influenza A & B.

Labs that are sent out will be billed separately by the reference lab. Some splints and crutches and nebulizer air compressors are billed separately by the companies supplying them.

I got stitches in my face due to an accident. It was done by a plastic surgeon. How long should I ice the swelling (how often, for how many days)? Any idea how long it takes for facial swelling to go down? There is no real pain involved. (Thankfully!)

Unless instructed otherwise by the plastic surgeon, you may ice the swollen tissues for 2 to 3 days, longer if needed. Generally, we suggest that you apply the cool pack 20 minutes on / 20 minutes off while awake the first 2 to 3 days. Always put a cloth between the ice pack and your skin to avoid frostbite and skin damage.

I have a wisdom tooth growing in and I think there's an infection now because my cheek and gums are swollen. It is very painful and I have pain going from my jaw to my left ear. I do not know if I should go to an urgent care, I don't have dental insurance so i dont know where to turn. Would u recommend me visiting Ultimate Urgent Care?

Urgent cares are able to prescribe antibiotics for dental infections as well as pain medication, both important to your condition. Even if you are treated by an urgent care for the infection, you should ultimatedly be seen by a dentist.

I currently take atenolol and avapro to control my high blood pressure. Last week, I took care of my grnadaughter who was suffering with strep throat. Within a few days, my blood pressure increased drastically even with my meds. Can my exposure to strep be the reason for the spike in pressure?

Generally speaking, exposure to strep without coming down with the illness will not affect your blood pressure.

Does this facility have ultrasound?

Ultimate Urgent Care Center does not do ultrasound at this time.

What kind of condition would be appropriate for an urgent care visit?

Urgent care centers are open to care for the community without the need for appointment and they are open for extended hours providing services long after the doctor offices are closed.

Urgent Care centers are used for those conditions; both illnesses and injuries, for which you would usually go to your family doctor. This would include mild to moderate illnesses like coughs, colds, rashes, earaches, fevers, urinary tract infections, the flu, and even asthma attacks. Minor injuries like scrapes, sprains and pulled muscles would be another set of conditions seen best at the family doctor’s office as well as at an urgent care center.

There are even some conditions that the urgent care center can handle that many people might not expect. For instance, one might consider only going to an emergency room at a hospital for lacerations that need stitches and for minor or moderate burns and possible broken bones.

Many urgent care centers can expertly provide wound care including suturing lacerations, tetanus immunization update and caring for the initial management of minor and moderate burns. Urgent care centers that have Xray equipment can diagnose and then splint broken bones too. Chest xrays can be done to help diagnose pneumonia and other diseases of the chest also.

Many urgent care centers can do EKG’s.

Urgent care centers can often perform many routine lab tests right there at the center allowing you and the doctor to get results in less than 20 minutes.

Unlike your family doctor, though, the urgent care center doesn’t attempt to manage and regulate chronic conditions like diabetes, hypertension, cardiac disease or emphysema, just to name a few. On going follow up care is best done by the family doctor. Urgent care centers CAN however see you on an acute basis for these very same conditions when the need is urgent and you can’t get into your doctor. This is a part of the service urgent care centers are designed to provide to the community.

You need to know what your local urgent care center can handle in order to make good decisions about where to go when you are ill. Referring to their web site and/or calling them can answer many of your questions.

If a person comes into an urgent care center with a life threatening or critical illness, the urgent care center should stabilize the patient to the best of it’s ability while calling for ambulance transport to the ER.

REMEMBER
Any life threatening illness or injury requires an IMMEDIATE call to 911. True emergencies belong in the emergency room.

For everything else, however, the urgent care is a great alternative that will save you a lot of time and hopefully provide you with a much more pleasant and economical visit ...

... AND we do it all during convenient hours without an appointment.

Urgent Care Medicine -- Here to Serve the Community -- Here to Serve YOU



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How Do I Know If My Child Broke a Bone?

In almost all cases, it takes a significant force to break the larger bones of our bodies like the arms and legs, hips and shoulders. Falls, being hit by a heavy hard object and being involved in a moving vehicle accident are examples. The smaller and lighter bones of a child may even be broken by excessive force if a limb is held tightly while the child is moved abruptly.

Children’s bones are relatively soft compared to the harder, more brittle adult bones and because of this, they tend to bend a little before breaking. This may cause the child’s bone to break on one side of the bone but not the other. Adult bones will usually break all the way through.

Many people are confused about the word break or broken and the word fracture. In reality, there is no difference between these terms in the medical profession. Officially, doctors use the word fracture for any broken bone no matter how minor, no matter how “hair line” or how wild the break may appear on the x-ray. When speaking to one another or when reporting the fracture in the patient’s medical record, doctors will describe the fracture’s characteristics so that any other doctor will understand and perfectly picture the break just by the description. The seriousness of the break will be obvious to them by this description and proper care will then be more easily and quickly ordered.

If your child has fallen, twisted an ankle or received other trauma that might have injured the bone, they will have significant pain that persists. It does not get very much better with time. Additionally, there may actually be a deformity present that is rather obvious. If the limb is bent, or angulated, it is broken or if near a joint it may be dislocated. Some accidents cause both a fracture and a dislocation. Almost all fractures are accompanied by swelling. Check for pulses past the injury, toward the end of the limb or check to see that the blood quickly refills back in the skin after pressing or squeezing a finger or toe. A lack of circulation past the break is a true emergency that must be seen at the hospital emergency room right away.

First aid measures for injuries that may be fractures include immobilizing the limb or area of injury, elevating it above heart or hip level when possible, application of ice and giving acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) in the child’s normal dose as indicated on the package instructions. For the best pain control you may give both acetaminophen and ibuprofen together as a starting dose. Remember though, acetaminophen is given every four hours and ibuprofen is given every six. Write down the times you give each or you will never be able to keep them straight! When you put ice on an injury you must put a thin piece of material between the ice and the skin to prevent frostbite. Yes, it may surprise people to know that ice can freeze and damage the skin by causing frostbite. Frostbite is a serious skin injury. Avoid it.

If the injury looks like a fracture, there will be no question about it and you will need to take your child to the urgent care center or to the hospital emergency room. Many urgent care centers can x-ray and splint broken bones just like the hospital and they will be able to refer you to an orthopedic specialist for further care of the injury. This is the standard of care for most fractures whether seen in the urgent care center or in the ER.

If you aren’t sure whether there is a break, but the patient has persistent pain that just isn’t getting that much better, and especially if they can’t use the injured part of the body, there may be a fracture and an examination by a physician is needed. This will probably involve ordering x-rays too. Inability to move the shoulder, elbow, wrist, finger, foot, ankle or toe, or inability to put weight on a foot, ankle or leg is a good indication that there may be a fracture. Immediate and significant swelling after the injury also raises our suspicion of a fracture. Only an x-ray will be able make the determination.

Any major injury or a failure in improvement of what you thought might have been a minor injury, should be evaluated by a healthcare provider.

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I have taken colon clense for about a week and stopped it about 5 days ago, in the mean time I have had bad pain on my left side under my rib cage and the pain goes to my back. I cannot sleep on my left side or sit comfortably, I have tried immodium thinking that I was constipated but it didnot work that great I am still having pain, any suggestions that you have it would be greatly appreciated. Thank you Shannon

Your abdominal pain should be evaluated by a physician who is able to order x-rays and labs as needed.

Immodium treats diarrhea by slowing the intestines down. If your pain is due to constipation, then Immodium will not help and may further constipate you.

Without being able to obtain further information from you, ask you more questions about your pain, bloating, bowel movements and more, and without being able to do a physical exam or obtain x-rays and labs, we cannot advise or diagnose over the web.

Please see a doctor for your abdominal pain as soon as possible.




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I am 40 and have severe lower back pain. My left leg goes numb as I walk and has lately gotten worse. While sitting it feels like someone is stabbing my back. I don't have insurance but feel I need to get checked, is there anywhere that I can go that will take me without insurance? Or is this something serious enough to worry too much about?

Numbness in the leg associated with your back pain might represent inflammation of the sciatic nerve, commonly called sciatica. Sciatica can be caused by muscle spasms, by sacro-iliac joint dysfunction, OR it may represent a more serious condition involving a bulging disk causing pressure on the nerves exiting the spine.

If muscle weakness in the foot or leg happens, you need to immediately go to the ER for evaluation and treatment. If your condition is due to pressure from a bulging disk and it is causing pain and muscle weakness, it could result in permanent damage to the nerves.

What do I need to do for a pulled muscle in the back of my leg?

Usually, a pulled muscle responds best to ice. We advise that you apply an ice pack that has a thin cloth covering so you don't damage the skin with too much cold. Apply it to the sore muscle area 20 minutes on / 20 minutes off, while awake for at least 2 days.

Also, if you have no allergies to aspirin or related medications called NSAIDS (like ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox, Naprosyn), then you will probably benefit from taking one of these according to their package instructions for 5 to 7 days. Take them with food to help avoid stomach irritation.

As the pulled muscle improves, you may need to do gentle stretching exercises. Pain will be your guide. If it hurts, stop. Re-attempt a few days later and remember, be gentle. Let it heal.

In addition to the above, after your initial 2 to 3 days of ice applications, it may respond to moist heat. We then advise moist heat (hot washcloth, soak in hot bath or hot tub) for 20 minutes, 4 times a day.

If these suggestions are not helping and you are not improving, or if you are worse at any time, you should be examined by a physician or other healthcare provider.

Hello. I've been in 2x in the last 5-6 months w/resp. infections. Over the last week to 2 weeks I've been coughing, primarily at night & during the day. There have been times where I've coughed hard enough to make me dry heave (I have'nt thrown up from it). Over the last 2-3 days my cough has become more "flemy". On tues & weds, I was wheezy when I would cough. I haven't had a temp over 99.5. Does this sound like another resp infection or more along the lines of acute bronchitis? THanks for your time!

Acute bronchitis actually is a respiratory infection of the larger airways in the lung. You may need a chest x-ray to rule out other reasons for the cough and you may need to consider the role seasonal allergies are playing in your case. Recurrent sinus infections can cause bronchitis too.

Getting the chest x-ray and another exam will be important, as will be follow up visits with either your primary care provider or a specialist if the urgent care doctor feels you need a referral.

Why Do Kids Get Ear Infections?

There are two kinds of common ear infections that can affect both children and adults. It is true that children suffer more often from these conditions than do adults and there is a reason for this.

First however, let’s look into the ear and learn about the two kinds of infections. The ear is divided into sections. We have the outer ear that sticks out and looks, well, like an ear. In the center of the ear is the opening to the ear canal into which travel the sound waves we hear. The ear canal is divided into the external portion and the middle ear by the ear drum. The ear drum, or tympanic membrane, vibrates as the soundwaves strike it. It transfers those vibrations to the small bones of the middle ear. The vibrations continue through those tiny bones to the inner ear which is the actual sensory mechanism that transfers the vibrations into nerve signals that then go to the brain. Today we are discussing infections of the external ear canal and the middle ear, but not the inner ear.

As long as the ear drum is intact and has no hole in it, water, dirt and germs do not get past it into the middle ear. The middle ear is connected to the outside however, by the Eustachian tube which leads into the back of the throat.

The two most common ear infections involve the external portion of the ear canal and the middle ear. Both of these infections cause pain and both can cause drainage from the ear.

An infection of the external ear canal is called Otitis Externa by the doctors but the rest of us call it Swimmer’s Ear. It often, but not always, can be caused by getting irritating or dirty water in the ear. Otitis Externa is actually an infection of the skin of the ear canal and can be caused by a scratch when you try to get that wax out or take care of an annoying itch. Because the infected and tender skin of the ear canal is attached to our ear, Swimmer’s Ear is painful when you tug or move the ear around. The canal becomes red, swollen and often drains pus.

Speaking of wax, why do we have it? Ear wax, or cerumen, is sticky and most dirt and debris that may get into our ears will stick to it and be trapped. The wax also sticks to the ear canal skin which slowly grows in an outward spiral direction carrying the wax with it ever so slowly to the opening of the ear where it falls out every once in a while. So ear wax is actually the body’s own ear cleaning mechanism.

The other common ear infection is Otitis Media, or infection of the middle ear. Unlike Otitis Externa, infections of the middle ear don’t hurt when you tug on the outer ear. They still hurt quite a bit all on their own. Fluid, pus and pressure build up in the middle ear and the ear drum becomes red and painful. How do these occur when no germs can get past the ear drum? The eustachian tube functions as a connection to the outside world so the middle ear can equalize the air pressure inside itself. This is necessary because the pressures outside change with the weather and with altitude changes and the flexible ear drum would bulge out or be pushed inwardly if the pressures behind it were not equal with the outside world. We’ve all experienced this problem when our ears pop during air travel.
The eustachian tubes drain minute amounts of mucus out of the middle ear constantly. The mucus is a bit sticky, but thin, and it carries any germs that may have gotten into the middle ear out and back down into the throat. Unfortunately, with allergies and colds, the eustachian tube can become swollen. When this happens pressures don’t equalize and germs aren’t moved out allowing them to take hold and infect the middle ear.

The reason children seem to get more middle ear infections than adults is that their eustachian tubes are very small and more easily blocked by swelling. Additionally, their facial anatomy causes the tubes to lie more horizontally than the adult’s and this makes it harder to continually drain the fluid and germs from the middle ear. As their faces grow and take on the more elongated and oval appearance of the adult, they “outgrow” their ear infections because the Eustachian tubes are more vertical.

If the pressure and pus build up too much in the middle ear, the ear drum can rupture allowing the pus to drain. This will often cure the infection and usually brings immediate pain relief. We generally prefer to treat the infection with antibiotics before this happens hopefully preventing it and the severe pain that leads up to it. Painful ear with fever usually indicates middle ear infection. If the ear is very tender to tugging, then it is probably Swimmer’s Ear. Both benefit from antibiotic therapy. See your doctor.


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I have a sudden onset of an earache with a stuffed up nose. Do I need to come in or can I treat it with something over the counter there are no other symptoms

Stuffy nose with ear pain is many times a dysfunctional eustachian tube. If the nose is stuffy, the eustachian tube can be swollen shut too. This prevents the middle ear from adjusting air pressure to match the outside and pain can occur if too much or too little air pressure is inside the middle ear pushing or pulling on the eardrum.

Often, if you simply decongest, the ear pressure and pain will be relieved. Over the counter decongestants or nasal sprays along with a mucus thinner like plain Robitussin or Mucinex, PLUS drinking a lot of water will help. Drink more than two liters of water a day to help thin out the mucus.

If fever develops or pain is severe, you should come in and be examined.

a couple days ago i put hydrogen peroxide in my ear because of a rash on my outer ear. Well when i leaned over to drain it out, a lot came out but not all of it and it felt like i had pressure behind my ear drum, the next day my ear was completely plugged up and my ear is constantly throbbing, i have tried rubbing alcohol, the hair dryer and nothing works. what do you suggest i do or what is the problem?

I would suggest you have a doctor examine you, look in the ear and find out what is actually going on with the ear.

My daughter fell and hurt her tail bone I want to make sure it didnt get chipped do you xray that area?

Yes, we certainly can do tailbone x-rays. We are able to do all of the "regular" x-rays, also called plain films.

We do not do special studies such and Upper and Lower GI's and we do not do CT Scans, Ultrasounds, Nuclear Scans or MRI's.

Good old regular x-rays of the bones (including tailbones), chest and abdomen are easily done at Ultimate Urgent Care Centers.

Thank you for asking.


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MY DENTAL DISCOUNT PLAN DOES NOT START UNTIL 2/10/09, ORAGEL NOT WORKING. CAN I GET SOMETHING FOR THE PAIN IF I COME IN?

We are able to do many dental blocks by injecting local anesthetics like the dentist does for immediate pain relief. The doctor may then decide you need an antibiotic and pain prescriptions also. You will ultimately need to see the dentist and we can refer you if you don't have one.

I HAVE HAD A COUGH FOR MORE THAT 1 WEEK ... AT NIGHT IT IS WORSE SOMETIMES I WILL THROW UP . I HAVE BEEN COUGHING UP GREEN FLEM..AND HAVE SOME SLIGHT CHEST TIGHTNESS... COULD THIS POSSIBLY BE BRONCHITIS ?

This sounds very much like acute bronchitis but it could also be pneumonia. We recommend an exam by a physician who may order a chest x-ray to check for pneumonia if indicated by the findings of the exam.

Is there any rule of thumb on how long/deep a wound would be to require stitches versus simply treating with bandaging?

Generally speaking, if the laceration is deep enough to have gone through all the layers of the skin exposing the fat tissue or muscle, it will require stitches, also known as sutures. Another consideration is whether or not the wound stays together by itself as opposed to gaping wide open. Gaping wounds should be sutured because they will never close by healing the edges together. Instead, these gaping wounds will heal from the bottom up, filling in the gap slowly by a process called "secondary intention", taking weeks as compared to a wound closed with stitches which heals in a matter of days. We feel that this slow process can add to the risk of infection since the wound is open for so long.

Additionally, we want to take into consideration the location of the wound. For cosmetic reasons, facial wounds look better after healing if they are properly closed. Wounds that heal by secondary intention tend to have much larger, wider scars. Some locations of wounds, like on the knee or elbow should be sutured because of the tendency to pull the edges apart every time we move. These areas don't heal well if not sutured.

All wounds must be thoroughly and properly cleansed prior to closing and bandaging, otherwise we are covering up and closing in all the germs that entered the wound from the skin and in doing so we are providing a great place for them to grow and infect the wound.

When in doubt about whether or not a wound requires stitches, it is best to have a doctor look at it and give you his or her opinion.







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How many hours after an injury can you no longer get stitches?

There is no set time for how long is too long for stitches after receiving a laceration but the rule of thumb has historically been 5 - 6 hours. This was based, however, on a questionable study done about 50 years ago. Now a days, in reality, a doctor should look at it and make the decision whether it's been too long. Many times we can close a wound with stitches well passed the 5-6 hour "limit".


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How long does the tingly feeling last after a thumb has been severely cut? i had stitches on it and i thought things would be okay but its been almost 2 months after the cut and i still feel my thumb tingling. its kinda annoying coz its my left thumb so i couldn't write a single word. please help.

When you lacerate the skin you actually cut the tiny skin nerves at the same time and this will often leave one or both sides of the cut with a tingly feeling.

It takes these nerves anywhere from six weeks to six months to regenerate and get back to normal. Sometimes, however, normal feeling doesn't ever return. In most cases, you will get normal feeling back eventually. My rule of thumb is that if you don't have normal feeling after 12 months, it's probably not coming back.

What can you tell me about the flu and getting a flu shot?

The flu is caused by the influenza virus and is a respiratory illness.

Getting your flu shot, usually offered beginning in October, is very important especially for the elderly, the young and the immuno-compromised patient. In fact, in these types of patients the flu can be very serious and sometimes even fatal.

The flu shot is made from a killed virus, so the vaccine will NOT cause flu symptoms. Remember though, it takes two weeks to build up full immunity to the flu from the time you receive your shot.

Does the flu shot hurt? Well, if the vaccine is given with a small skinny needle, it's hardly even a pinch. Kids tell us that it didn't even hurt. So make sure your doctor uses something small like a 30 gauge needle. Your arm may get sore after the shot though, and the best thing to do is move it around and take some ibuprophen. Most people don't even need to do this however.

If you receive the nasal spray flu vaccine, you may have mild symptoms afterward because this kind of vaccine is made from weakened, or attenuated, virus. So, if you are at high risk for infections, such as in an immunocompromised state (AIDS, asplenia, undergoing chemotherapy), you should NOT get this form of vaccine. Have your doctor advise you because when in these high risks states, you should be vaccinated to protect yourself from the flu. In most of these cases the shot will be the proper choice for you. ASK YOUR DOCTOR.

Pregnant women should be vaccinated, but should get the SHOT, and NOT the nasal spray form.


FLU SYMPTOMS

When a person comes down with the flu, they may have achy muscles and joints. They will usually have a fever, head cold-like symptoms as well as a nonproductive, tight, wheezy cough, which are all hallmarks of the flu.

Associated symptoms range from sore throat and headache to fatigue and weakness. The flu lasts about a week. It is primarily spread through droplets from sneezes and coughing, and a person with the flu is contagious from one day before their symptoms show up through the five days after that.

Other more serious illness that in some respects may mimic the flu include pneumonia, sinusitis, strep throat and acute bronchitis. If you are coughing up colored sputum and your fever is greater than 101, it would be wise to go to the doctor, the urgent care center or even the emergency room. For information on how the “pneumonia shot” helps protect us, look for information here in the “Answers to Medical Questions.” For more information about the flu, go to www.cdc.gov/flu/keyfacts.htm.




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I'm concerned about lead exposure lately.

Recent recalls of products, specifically toys, produced in China have shed light on the dangers of lead-based paint and have a lot of people concerned.

The effects of lead can be mild to devastating in the human body. Symptoms and problems related to lead exposure can occur when exposure levels reach above 100 ppb in adults, but in children who are still developing, serious neurological problems can occur with blood levels well below the 100 ppb mark.

Symptoms of chronic lead toxicity can include anemia, neurological problems like slower or severely impaired mental development, reduced cognitive abilities, headaches, excessive lethargy and in really extreme cases, seizures and coma.

Milder, but serious symptoms, of lead toxicity include nausea, abdominal pain, irritability, insomnia, and a metallic taste in the mouth.

In cases of acute or recent exposure, symptoms may include constipation, diarrhea, vomiting, poor appetite and weight loss. Kidney and reproductive problems can also occur.

If you think you or someone you know may be suffering from lead exposure, you should talk to your doctor about being tested.




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I just moved to AZ from FL and would like to have a prescription (lorazepam) continued on a regular basis. I do not have any insurance and can pay from out of pocket.

You are welcome to come into the urgent care center for an evaluation. If a prescription is deemed necessary, we will be happy to write it. We will also recommend a family doctor to you for future prescriptions if needed.

What is the best way to treat food poisioning?

Food poisoning usually results in nausea, vomiting and diarrhea. It may present just like what we all consider to be the "stomach flu". It can be caused by bacteria or viruses contaminating the food we eat. Because of this, others that ate the same food as you will probably be sick just like you are. This part of the medical history investigation is important to know and will help you and your doctor figure out the cause of your illness. The symptoms can begin fairly quickly or take as long as 12 or 24 hours to appear. In most cases, the illness is self limited and will resolve in 24 to 48 hours, sometimes as long as 72 hours. Dehydration is a concern due to all the diarrhea and vomiting which can be severe at times. Rarely, food poisoning can be dangerous and even fatal due to toxins released by the contaminating bacteria. An example of this would be botulism which occurs in canned foods and begins with the progression of profound weakness and blurred or double vision. Luckily for us, botulism is easily prevented by cooking the food that was in the can or jar.

Most of the common food poisonings however, are simply the gastroenteritis variety in which we see the nausea, vomiting and diarrhea. Because these symptoms can be severe at times, especially for children and the elderly who cannot tolerate dehydration as well, you should see your doctor if you suspect you may have food poisoning. What you ate and where you ate are important too because if we begin to see a pattern with a particular type of food, or from a particular restaurant, we can notify the health department which will take steps to identify the tainted food source and remove it from the shelves in order to prevent more cases.

Allowing the stomach to rest for two to three hours with nothing taken by mouth will sometimes give enough time for the nausea, vomiting and diarrhea to subside. At that point, you can begin taking one ounce sips (half ounce for toddlers) of water every 30 minutes for an hour or so. If the sips stay down and you have no diarrhea as a result of them, you can begin to increase the amount of water by one ounce (half for the kids) each 30 minutes. If this fails, you should see a doctor who will be able to further evaluate you and perhaps prescribe some medication for the nausea and diarrhea in order to prevent dehydration.




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I have some questions about my child's fever.

We'd be happy to answer your important questions:

How high do I let my child’s fever get before I should get concerned?

Most fevers are not concerning. Most pediatricians consider any thermometer reading above 100.4 degrees Fahrenheit (38 degrees Celsius) a sign of fever. If your child has a fever it is probably a sign he or she is fighting a bacterial or viral infection. Fevers do not harm your child and may help your child fight the infection. Fever is a good sign that your child’s immune system is working and the body is trying to rid itself of the infection. If your child has a fever you may notice his or her heart rate will naturally speed up. She may appear flushed and perspire more than usual.

While most fevers don’t require a visit to the pediatrician or ER, there are certain circumstances when a fever could indicate something serious:

Looks very ill, is unusually drowsy or very fussy
Has been in an extremely hot place, such as an over heated car
Has additional symptoms, such as stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea
Has had a seizure
Is younger than 3 months of age and has arectal temperat ure of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher




How do I do to treat my child’s fever at home?

A child who i s over 6 months of age and has a temperature below 100 degrees Fahrenheit (38 degrees Celsius) probably does not need to be seen or treated for the fever. Observe her behavior. If your child is eating and sleeping well, you may wait to see if the fever improves by itself. You can do the following to make them more comfortable:

Keep their room comfortably cool
Dress in light clothing
Encourage them to drink fluids, such as water, diluted fruit juices, or commercially prepared oral electrolyte solution
Do not let her over exert herself


You can also give your child some over the counter medication to reduce the fever. Both acetominophen and ibuprofen are safe and effective. The proper dosage must be given. Weigh your child and ask the pharmacist for assistance in dosing the medication. You may also sponge your child with lukewarm water.Do not use cold water or ru bbing alcohol.

Ibuprofen should only be used in children over 6 months of age. It should not be given to children who are vomiting constantly or dehydrated.Do not use aspirin. Aspirin has been linked to stomach bleeding and more seriously, Reyes syndrome.

Call your pediatrician or bring to ER if your child still “acts sick” once the fever is brought down, or if you feel that your child is very sick. Also call if the fever has been more than 24 hours in a child younger than 2 years of age or more than three days in a child 2 years of age or older.




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What are the signs of a heart attack?

A heart attack, or Myocardial Infarction, occurs when blood supply to a portion of the heart muscle is interrupted and the muscle tissue begins to die, or necrose, because of a lack of oxygen. Blood supply is usually interrupted in a heart attack by a small clot forming in one of the coronary arteries feeding the heart muscle. The clot usually forms at a very narrow spot caused by cholesterol plaque build up.

Classically, the signs of a heart attack include chest pain. The pain can be mild to severe and is often a pressure sensation like, "an elephant", sitting on your chest. The pain can instead be sharp, dull, burning or feel like indigestion or heart burn.

Associated signs and symptoms often include one or more of the following:

Shortness of Breath
Sweating: Clamminess to dripping wet
Nausea and sometimes vomiting
Lightheadedness or almost fainting
Marked weakness

Sometimes people will feel palpitations, or a fluttering in the chest along with the pain.

Often times the pain will radiate to the shoulder, the back, the jaw or down the arm. The arm can ache, feel numb, feel heavy or tingly. This radiation of "pain" can be on either side; left or right, or both!

It is important to remember that some conditions like diabetes can mask the pain and eliminate it all together. So, in those patients, feeling extra weak and having some of the associated symptoms mentioned above may be the only clue that a heart attack is in progress.

We have a saying in the ER:
Time is myocardium!

This means that the quicker you get the proper care for your heart attack, the less heart muscle will be damaged and the better the outcome. This can mean the difference between having a mild heart attack with only minimal problems, to having a major one associated with severe, debilitating side effects the rest of your life. It can also mean the difference between surviving a major heart attack or dying from one.

If you or someone you know is having any of the above mentioned signs or symptoms, you should call 911.




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Why does the left side of the body ache during a heart attack

A heart attack is caused by the blockage of blood flow to a portion of the heart muscle tissue. Think about the pain that would occur if you put a tight rubber band around your finger. Within a minute or two you start to experience some pretty intense and intolerable pain. This is due to a lack of oxygen getting to the tissues of the finger. Your heart muscle actually starts to hurt when it's blood supply is blocked just like the finger. Since the largest part of the heart is situated to the left of the breast bone (sternum) in the chest, people tend to feel the pain on the left.

The pain associated with a heart attack can radiate too. It can radiate to the left shoulder, left arm and elbow and all the way to the fingers. Likewise, it may radiate to the right shoulder, arm, elbow or fingers. It may radiate up the neck on either or both sides and cause aching in the jaw(s). Sometimes the pain will radiate to the back.

Where the pain is located and where it radiates, if it does, can depend on what part of the heart muscle is being affected, or starved of blood supply and therefore, oxygen.

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My question is what drug besides TPA is used to dissolve a blood clot in an emergency room?

There are several medications available today. In most larger hospitals that have interventional cardiologists and a cardiac cath lab, the patient will have direct opening of the narrowed coronary artery by the cardiologist using a balloon on the catheter, or with a stent, thereby reversing the heart attack and preventing it from recurring.

In hospitals without that level of intervention, medications like TPA or it's more popular smaller molecule form called TNK will be used to dissolve the clot blocking the artery at it's narrowed, cholesterol plaque area, restoring blood flow to that portion of the heart, temporarily salvaging the heart muscle, and in effect, reversing the heart attack.

Examples of medications like TPA and TNK are Retavase, streptokinase, urokinase, and others.




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Hi, I get fluttering in my chest, I am on Lisinipril for High blood pressure (2.5 mg) I had the fluttering before going on the medication. I seem to get this quite often, no pain with it. I have had a stress test on the treadmill, cat scan and ekg, however none of these when this happens. I also have been getting off and on sharp and mild pains in my chest for a very long long time. Any advice?

Ask your cardiologist to perform a test called Event Monitoring. It will hopefully catch the fluttering beats so that he or she can analyze them and let you know if they are anything to worry about. The cardiologist will have recommendations for you based on what kind of irregularity in the heart rhythm you are actually experiencing. Another test that may be indicated is an echocardiogram. Discuss having both of these tests with the cardiologist. Neither is invasive (no needles). The Event Monitor is like a really small EKG that you stay attached to for 24 to 48 hours while you go about your normal daily life and the echo is like an ultrasound of the heart.

You should also have a blood test to make sure your electrolytes and your thyroid are normal. The cardiologist can order those tests too.

The sharp pains should be mentioned to the cardiologist as well. These could be related to the heart, but on the other hand, may not be. The cardiologist can help figure that out.

Thank you for your question.

Dr. Welch




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I HAD A HEART ATTACT AT 7:30 ON DEC.1,2004. I WAS AT MY LOCAL HOSPITAL IN 10 MINUTES AND WITH -IN THE HOUR I WAS STABELIZED AND TRANSPORTED TO TH VA IN MEMPHIS, TENNESSEE AND BEFORE NOON THEY HAD ME IN THE CATH LAB AND PLACED TWO SRENTS IN MY RIGHT CORONARY ARTERY. I WAS STILL IN THE PROCESS OF HAVING THE HEART ATTACT. MY QUESTION IS DID THEY INTERUPT OR STOP THIS HEART ATTACT?

A heart attack is when the heart muscle actually begins to die. It is completed when the muscle cells in the area of the heart attack are dead and can no longer function. In your case some of the cells may have died, but you may have had the blockages opened up before permanent damage and cell death occurred. It sounds as if you were still in the process of having the heart attack and even if some of the cells did die, the doctors prevented damage to a bigger area, thereby limiting the size of the heart attack.


Testing after the fact will be able to show if any of your heart muscle died. An EKG can show this and an echocardiogram, or ultrasound of the heart, will show even more evidence. If these are normal, then your heart made it through without damage. If they are a little abnormal, then it was affected slightly. As you can imagine, if the tests show that a large portion of the heart muscle was damaged, then that's what happened.

Talk to your cardiologist about how much, if any damage your heart received as a result of your heart attack. It sounds as if you sought and received treatment quickly, and this can make all the difference in the world in how much damage the heart attack does.

You responded to your symptoms as quickly as you could, and that's fantastic.

Thank you for this great question. I hope we have answered you satisfactorily.

Dr. Welch



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What is a stroke?

A stroke is a condition that causes death of brain tissue.

Brain tissue death is usually caused by interruption of blood flow to that tissue. This can be caused by a blood clot in a vessel blocking the blood supply to an area of the brain, or by the rupture of a blood vessel causing bleeding in the brain.

Strokes result from vascular disease.

Narrowed arteries with cholesterol plaque are easily blocked by a small blood clot.

Narrowed cholesterol filled arteries can actually cause clot formation if the cholesterol is brittle and develops small cracks in it's surface.

A weakening of an arterial wall can lead to the formation of a small aneurysm, or bulging area that may burst causing bleeding and loss of blood flow to areas of the brain supplied by that artery.

High blood pressure plays a large roll.

High blood pressure, over time, damages arterial walls leading to areas that allow cholesterol plaque to adhere and build up. Fluctuations in blood pressure can then crack cholesterol plaques attracting clot formation. High blood pressure can also cause an aneurysm to form and to later burst.

Strokes are sometimes called Cerebrovascular Accidents, or CVAs.

When a portion of the brain dies, that portion no longer functions and the person is left with a "neurological deficit". This can be a loss of sensation on one side of the body or face, a weakness or total loss of muscle use on one side of the body or face, an inability to speak, or a combination of all of these. Severe strokes can cause coma and death.

In many cases, the earlier a developing stroke is diagnosed and treated, the less damage is done to the brain tissue and the less the resultant permanent deficit. There are cases of strokes being reversed in the emergency department by use of clot dissolving medications.

As with many medical emergencies, when it comes to a stroke, the sooner treatment begins, the better the outcome.

At the first signs of a stroke, go directly to the ER or CALL 911. DO NOT WAIT.




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Why did I get pneumonia even though I had the pneumonia shot?

Pneumonias can be caused by a variety of bacteria such as Staph, Strep, Klebsiela, as well as other bacteria and even other kinds of germs.

Pneumovax, the pneumonia vaccine or Pneumonia Shot, protects you from Strep Pneumonia only. Strep pneumonia was the most common and is one of the most serious forms of pneumonia. The vaccine was developed to protect susceptible people from catching this particular germ and developing the pneumonia that it causes.

There are many other germs out there that can cause pneumonia. These range from viruses, such as those responsible for the common cold, to the one that causes chicken pox. Some of these, like the chickpox virus can be treated with special antiviral medications. Most viral infections must run their course as we do not have many antiviral agents for treatment. Some viral pneumonias however, can be severe and may require hospitalization in order to maintain adequate breathing and oxygen supply.

As we noted previously, pneumonia can also be caused by bacterias like those mentioned above. These are treated with antibiotics. If the infection is severe, these will be administered in the hospital and the patient's breathing and oxygen requirements will be supported too.

Additionally, pneumonia can be caused by tuberculosis and even some fungus.

Valley Fever is caused by a fungus that lives in the dusty desert soil. It is called coccidiodomycosis when it infects us and can cause a serious pneumonia. Special antifungal medications may be needed to fight off these infections.

"Walking Pneumonia", is the common term for a class we call "Atypical Pneumonias" and is caused by organisms such as Mycoplasma and Legionella. These respond quite well to certain antibiotics.

All pneumonias can be serious, some even life threatening.

Pneumonias are infections of the lung tissue itself. They can be painful because they inflame and irritate the tender lining covering the lungs. They cause fevers generally, shortness of breath and productive coughs.

You have luckily been protected from one of the most common and more serious forms if you've had the "pneumonia shot", but you may still come down with a pneumonia caused by the other germs.As we mentioned above, some of these can be serious .........

Therefore, don't hesitate to go to the Urgent Care Center, your doctor or to the ER if you are ill with a fever and cough, especially if you are coughing up yellow, brown, green or reddish sputum.

Remember too, we now know that the pneumonia shot is good for seven years at which time you will need to be revaccinated to continue your protection.

Who should be vaccinated? Generally speaking, people with compromised pulmonary systems like those with asthma, emphysema or chronic bronchitis. People with compromised immune systems also benefit from the vaccination. These would include people without a spleen, those on immunosuppressant medications, or those with HIV. Seniors in general are more susceptible to serious infection also and will usually benefit from being vaccinated.

Talk to your doctor about whether you need the pneumonia shot.




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Can you give us some facts about smoking?

FACTS

Smoking causes damage to the lining of the arteries. If you've read the answers to the questions above, you already know that leads to heart attacks and strokes.

Smoking causes less oxygen to get to all the tissues of the body even when you're not smoking, like between cigarettes and even when you're sleeping because of all the carbon monoxide you inhale and put into the blood stream every time you light up. Tissues that don't get enough oxygen don't work as well as they should. This includes YOUR BRAIN.

Smoking damages the lining of the lungs leading to irreversible pulmonary diseases like emphysema.

SMOKING GREATLY INCREASES THE CHANCES THAT YOU WILL DEVELOP LUNG CANCER.

Still, some people think smoking makes you look and feel cool around your friends.

Let's talk about being cool .........

Not being able to even go to the store without a tank of oxygen attached to your nose ISN'T COOL.

Having open heart surgery to fix your clogged arteries so you won't die ISN'T COOL.

Lying in bed unable to talk or move one side of your entire body for the rest of your life because of a stroke ISN'T COOL.

Lung cancer is way not cool. Don't EVEN go there -- you DON'T want too.

So get smart, be cool and DON'T SMOKE!

Look ............

HAVING THE RIGHT TO CHOOSE NOT TO SMOKE IS WAY COOL!

BEING SMART ENOUGH AND STRONG ENOUGH TO NOT SMOKE TO BEGIN WITH IS THE COOLEST.

HAVING THE COURAGE AND STRENGTH TO QUIT SMOKING IS REALLY HEROIC AND SHOWS GREAT STRENGTH AND PERSONAL INTEGRITY.

BE A HERO -- YOU CAN DO IT -- YOUR DOCTOR CAN HELP




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I’m under a lot of stress and I take blood preasure med, I sit at home and don’t walk or run but i know I need to, I’m 5'6 and weigh 202. I’m a 42 year old female. Can aspirin help as well? And do I need to lose weight to help me as well? Please get me the information to help me.

It is extremely important that you go to your doctor and have a thorough physical exam before any recommendations can be made.

Getting out for a walk every day, in general, is a healthy recommendation as is losing weight and maintaining your ideal body weight and body mass index. How gradually you work into the exercise will depend on many factors that only you and your doctor can determine working together after both a complete medical history and a physical exam are done.

Taking aspirin daily is also advised for adults over 40, but only if you are not allergic to it or have other conditions that might make aspirin the wrong choice.

So you see, it is very important to speak to your doctor. You AND your doctor need to make a plan for your health.




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